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      Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

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          Abstract

          Background

          The maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions (east, central and west regions), and the mortality in the western region remains high. This study aims to examine how much disparity in the health system and MMR between ethnic minority and non-minority counties exists in Sichuan province of western China and measures conceivable commitments of the health system determinants of the disparity in MMR.

          Methods

          The MMR and health system data of 67 minority and 116 non-minority counties were taken from Sichuan provincial official sources. The 2-level Poisson regression model was used to identify health system determinants. A series of nested models with different health system factors were fitted to decide contribution of each factor to the disparity in MMR.

          Results

          The MMR decreased over the last decade, with the fastest declining rate from 2006 to 2010. The minority counties experienced higher raw MMR in 2002 than non-minority counties (94.4 VS. 58.2), which still remained higher in 2014 (35.7 VS. 14.3), but the disparity of raw MMR between minority and non-minority counties decreased from 36.2 to 21.4. The better socio-economic condition, more health human resources and higher maternal health care services rate were associated with lower MMR. Hospital delivery rate alone explained 74.5% of the difference in MMR between minority and non-minority counties. All health system indicators together explained 97.6% of the ethnic difference in MMR, 59.8% in the change trend, and 66.3% county level variation respectively.

          Conclusions

          Hospital delivery rate mainly determined disparity in MMR between minority and non-minority counties in Sichuan province. Increasing hospital birth rates among ethnic minority counties may narrow the disparity in MMR by more than two-thirds of the current level.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-4765-y) contains supplementary material, which is available to authorized users.

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          Most cited references16

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          Preventable maternal mortality: Geographic/rural-urban differences and associated factors from the population-based maternal mortality surveillance system in China

          Background Most maternal deaths in developing countries can be prevented. China is among the 13 countries with the most maternal deaths; however, there has been a marked decrease in the maternal mortality ratio (MMR) over the last 3 decades. China's reduction in the MMR has contributed significantly to the global decline of the MMR. This study examined the geographic and rural-urban differences, time trends and related factors in preventable maternal deaths in China during 1996-2005, with the aim of providing reliable evidence for effective interventions. Methods Data were retrieved from the population-based maternal mortality surveillance system in China. Each death was reviewed by three committees to determine whether it was avoidable. The preventable maternal mortality ratio (PMMR), the ratios of PMMR (risk ratio, RR) and 95% confidence intervals (CI) were used to analyze regional disparities (coastal, inland and remote regions) and rural-urban variations. Time trends in the MMR, along with underlying causes and associated factors of death, were also analysed. Results Overall, 86.1% of maternal mortality was preventable. The RR of preventable maternal mortality adjusted by region was 2.79 (95% CI 2.42-3.21) and 2.38 (95% CI: 2.01-2.81) in rural areas compared to urban areas during the 1996-2000 and 2001-2005 periods, respectively. Meanwhile, the RR was the highest in remote areas, which was 4.80(95%CI: 4.10-5.61) and 4.74(95%CI: 3.86-5.83) times as much as that of coastal areas. Obstetric haemorrhage accounted for over 50% of preventable deaths during the 2001-2005 period. Insufficient information about pregnancy among women in remote areas and out-of-date knowledge and skills of health professionals and substandard obstetric services in coastal regions were the factors frequently associated with MMR. Conclusions Preventable maternal mortality and the distribution of its associated factors in China revealed obvious regional differences. The PMMR was higher in underdeveloped regions. In future interventions in remote and inland areas, more emphasis should be placed on improving women's ability to utilize healthcare services, enhancing the service capability of health institutions, and increasing the accessibility of obstetric services. These approaches will effectively lower PMMR in those regions and narrow the gap among the different regions.
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            Assessing the spatial accessibility of hospital care in Sichuan Province, China.

            Regional disparities in geographical access to hospital care are found throughout China. Understanding variations in the spatial accessibility of hospital care has the potential to provide decision support in healthcare planning. This study examines the hospital system in the Sichuan Province in China, which provides healthcare for more than 80 million people. We examine the impacts of accessibility characterisation via the conventional measurement approach by comparing the results to those derived using a floating catchment area approach. Employing a geographical information system based on population and hospital administrative data, we conducted a province-wide study of the spatial accessibility of hospital care in Sichuan Province, China. A shortest-path analysis and the enhanced two-step floating catchment area (E2SFCA) method were implemented. Substantial differences between these two approaches were found, including a roughly 15% difference in the total number of under-served areas. Generally, spatial accessibility was higher in the eastern regions of Sichuan. More than 5.5 million people were found to have limited access, with large variations across the province. These results indicate that the official method used by policy makers in China may not capture the true nature of spatial accessibility throughout the region. We recommend that the E2SFCA method be implemented for health services research in China, providing decision makers with more accurate information when setting healthcare policies.
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              Determinants for high maternal mortality in multiethnic populations in western China.

              Our purpose of this study was to investigate determinants and patterns of associations with high maternal mortality in poor and multiethnic populations from the Xinjiang Uigur autonomous region of Western China. The researcher found that the maternal mortality ratio of Xinjiang was very high; almost half of the participants delivered at home without clean delivery, and nearly one-fifth of the participants had not received any medical treatment. Eighty-seven percent of maternal deaths were among ethnic minority groups. In multiethnic areas in Xinjiang, social-culture factors, lack of health resources, and low health services utilization were related to high maternal mortality.
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                Author and article information

                Contributors
                420737196@qq.com
                464723970@qq.com
                359678689@qq.com
                344399976@qq.com
                panjie.jay@hotmail.com
                yangmin2013@scu.edu.cn
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                29 September 2017
                29 September 2017
                2017
                : 17
                : 750
                Affiliations
                [1 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, West China School of Public Health, , Sichuan University, ; Chengdu, 610041 Sichuan People’s Republic of China
                [2 ]Sichuan Provincial Maternal and Child Health Hospital, Chengdu, Sichuan People’s Republic of China
                [3 ]Health and Family Planning Information Centre of Sichuan Province, Chengdu, Sichuan People’s Republic of China
                [4 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, West China Research Center for Rural Health Development, , Sichuan University, ; Chengdu, Sichuan People’s Republic of China
                [5 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, School of Medicine, , University of Nottingham, ; Nottingham, UK
                Article
                4765
                10.1186/s12889-017-4765-y
                5622414
                28962594
                6463b16b-df68-4b0b-8248-b6c8ee6c83aa
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 22 June 2017
                : 15 September 2017
                Funding
                Funded by: Countdown to 2015 for Maternal, Newborn and Child Survival
                Award ID: OPP1058954
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                ethnic disparity,maternal mortality rate,health system,china
                Public health
                ethnic disparity, maternal mortality rate, health system, china

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